Comparison of clinical and economic outcomes between high-intensity care and hospice care for the end-of-life melanoma patients

The intensity of care for patients at the end-of-life is increasing in recent years. Publications have focused on intensity of care for many cancers, but none on melanoma patients. Substantial gaps exist in knowledge about intensive care and its alternative, hospice care, among the advanced melanoma patients at the end of life. End-of-life care may be used in quite different patterns and induce both intended and unintended clinical and economic consequences. We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases to identify patients aged 65 years or older with metastatic melanoma who died between 2000 and 2007. We evaluated trends and associations between sociodemographic and health services characteristics and the use of hospice care, chemotherapy, surgery, and radiation therapy and costs. Survival, end-of-life costs, and incremental cost-effectiveness ratio were evaluated using propensity score methods. Costs were analyzed from the perspective of Medicare in 2009 dollars. In the first journal Article we found increasing use of surgery for patients with metastatic melanoma from 13% in 2000 to 30% in 2007 (P=0.03 for trend), no significant fluctuation in use of chemotherapy (P=0.43) or radiation therapy (P=0.46). Older patients were less likely to receive radiation therapy or chemotherapy. The use of hospice care increased from 61% in 2000 to 79% in 2007 (P =0.07 for trend). Enrollment in short-term (1-3 days) hospice care use increased, while long-term hospice care (≥ 4 days) remained stable. Patients living in the SEER Northeast and South regions were less likely to undergo surgery. Patients enrolled in long-term hospice care used significantly less chemotherapy, surgery and radiation therapy. In the second journal article, of 611 patients identified for this study, 358 (59%) received no hospice care after their diagnosis, 168 (27%) received 1 to 3 days of hospice care, and 85 (14%) received 4 or more days of hospice care. The median survival time was 181 days for patients with no hospice care, 196 days for patients enrolled in hospice for 1 to 3 days, and 300 days for patients enrolled for 4 or more days (log-rank test, P < 0.001). The estimated hazard ratios (HR) between 4 or more days hospice use and survival were similar within the original cohort Cox proportional hazard model (HR, 0.62; 95% CI, 0.49-0.78, P < 0.0001) and the propensity score-matched model (HR, 0.61; 95% CI, 0.47-0.78, P = 0.0001). Patients with ≥ 4 days of hospice care incurred lower end-of-life costs than the other two groups ($14,298 versus $19,380 for the 1- to 3-days hospice care, and $24,351 for patients with no hospice care; p < 0.0001). In conclusion, Surgery and hospice care use increased over the years of this study while the use of chemotherapy and radiation therapy remained consistent for patients diagnosed with metastatic melanoma. Patients diagnosed with advanced melanoma who enrolled in ≥ 4 days of hospice care experienced longer survival than those who had 1-3 days of hospice or no hospice care, and this longer overall survival was accompanied by lower end-of-life costs.^

End -of -life planning and decision -making: Implications for adults with mental retardation

This research focused on the topic of end-of-life planning and decision-making for adults affected by mental retardation. Adults with mental retardation have unique challenges in this regard, including difficulty communicating their wishes without assistance and diminished decision-making skills. The primary research objective was to identify factors that can affect opportunities for adults with mental retardation in community-based services settings (and their advocates) to be involved in planning and deciding about their own end-of-life experience. ^ A descriptive qualitative inquiry was designed to explore issues related to death and dying, and the notion of end-of-life planning, from the perspective of adults with mental retardation who receive publicly-funded community services ("clients") and family members of individuals who receive such services. Study participants were recruited from a single mental retardation service provider in a large urban setting (the "Agency"). Sixteen clients and 14 families of Agency clients took part. Client data collection was accomplished through face-to-face interviews, focus group meetings, and record reviews; family members were involved in a face-to-face interview only. ^ An initial coding scheme was developed based upon literature and policy reviews, and themes related to the research questions. Analysis involved extracting data from transcripts and records and placing it into appropriate thematic categories, building support for each theme with the accumulated data. Coding themes were modified to accommodate new data when it challenged existing themes. ^ Findings suggest that adults with mental retardation do have the requisite knowledge, interest, and ability to participate in decisions about their end-of-life experience and handling of affairs. Siblings are overwhelmingly the chosen future surrogates and they (or their children) will likely be the end-of-life advocates for their brothers and sisters affected by mental retardation. Findings further point to a need for increased awareness, accurate information, and improved communication about end-of-life issues, both in general and particular to adults affected by mental retardation. Also suggested by the findings is a need to focus on creating accommodations and adaptations that can best uncover a person's authentic views on life and death and related end-of-life preferences. Practical implications and suggestions for further research are also discussed. ^

Presupuestos del análisis cualitativo para el estudio de la toma de decisiones

Se toma como punto de partida el modelo de diseño de investigación cualitativa desarrollado por Joseph Maxwell, cuya concepción sobre el diseño de una investigación es el de una estructura subyacente basada en la interconexión de los componentes del estudio y las implicancias que estos tienen sobre otros, para analizar, si es posible, la corriente neorrealista, considerada como la escuela predominante en el estudio de las relaciones internacionales. El propósito de este trabajo -sustentado en el paradigma interpretativo, que conlleva como supuesto fundacional la necesaria comprensión del sentido de la acción social en el contexto del mundo de la vida y desde la perspectiva de los participantes- es el de relevar el aporte testimonial de quienes han conducido o participado activamente, es decir, los Ministros de Relaciones Exteriores, en la formación de la política exterior del país a partir de la vuelta de la democracia.

Políticas y territorios de escolarización en contextos de extrema pobreza urbana. Dispositivos pedagógicos entre el gerenciamiento y la abyección

Este trabajo se ocupa de caracterizar los dispositivos pedagógicos atendiendo a los modos en que las políticas y procesos de escolarización son vividos y pensados en territorio. A través de la discusión de resultados de investigación empírica que desarrollamos a lo largo de cuatro años en escuelas emplazadas en contextos de extrema pobreza urbana, intentamos describir las particulares formas en que la vida escolar es producida en estos espacios urbanos. Desde la perspectiva de los estudios de gubernamentalidad, procuramos la descripción de las formas que están asumiendo los dispositivos pedagógicos y la producción de subjetividad en territorios abyectos en los que, en el marco de las sociedades de gerenciamiento, la población ha quedado librada a su propia suerte. Propondremos una forma de leer las políticas educativas atendiendo a las formas en que son experienciadas por los sujetos en territorio.

Políticas y territorios de escolarización en contextos de extrema pobreza urbana. Dispositivos pedagógicos entre el gerenciamiento y la abyección

Este trabajo se ocupa de caracterizar los dispositivos pedagógicos atendiendo a los modos en que las políticas y procesos de escolarización son vividos y pensados en territorio. A través de la discusión de resultados de investigación empírica que desarrollamos a lo largo de cuatro años en escuelas emplazadas en contextos de extrema pobreza urbana, intentamos describir las particulares formas en que la vida escolar es producida en estos espacios urbanos. Desde la perspectiva de los estudios de gubernamentalidad, procuramos la descripción de las formas que están asumiendo los dispositivos pedagógicos y la producción de subjetividad en territorios abyectos en los que, en el marco de las sociedades de gerenciamiento, la población ha quedado librada a su propia suerte. Propondremos una forma de leer las políticas educativas atendiendo a las formas en que son experienciadas por los sujetos en territorio.

Presupuestos del análisis cualitativo para el estudio de la toma de decisiones

Se toma como punto de partida el modelo de diseño de investigación cualitativa desarrollado por Joseph Maxwell, cuya concepción sobre el diseño de una investigación es el de una estructura subyacente basada en la interconexión de los componentes del estudio y las implicancias que estos tienen sobre otros, para analizar, si es posible, la corriente neorrealista, considerada como la escuela predominante en el estudio de las relaciones internacionales. El propósito de este trabajo -sustentado en el paradigma interpretativo, que conlleva como supuesto fundacional la necesaria comprensión del sentido de la acción social en el contexto del mundo de la vida y desde la perspectiva de los participantes- es el de relevar el aporte testimonial de quienes han conducido o participado activamente, es decir, los Ministros de Relaciones Exteriores, en la formación de la política exterior del país a partir de la vuelta de la democracia.

Presupuestos del análisis cualitativo para el estudio de la toma de decisiones

Se toma como punto de partida el modelo de diseño de investigación cualitativa desarrollado por Joseph Maxwell, cuya concepción sobre el diseño de una investigación es el de una estructura subyacente basada en la interconexión de los componentes del estudio y las implicancias que estos tienen sobre otros, para analizar, si es posible, la corriente neorrealista, considerada como la escuela predominante en el estudio de las relaciones internacionales. El propósito de este trabajo -sustentado en el paradigma interpretativo, que conlleva como supuesto fundacional la necesaria comprensión del sentido de la acción social en el contexto del mundo de la vida y desde la perspectiva de los participantes- es el de relevar el aporte testimonial de quienes han conducido o participado activamente, es decir, los Ministros de Relaciones Exteriores, en la formación de la política exterior del país a partir de la vuelta de la democracia.

Políticas y territorios de escolarización en contextos de extrema pobreza urbana. Dispositivos pedagógicos entre el gerenciamiento y la abyección

Este trabajo se ocupa de caracterizar los dispositivos pedagógicos atendiendo a los modos en que las políticas y procesos de escolarización son vividos y pensados en territorio. A través de la discusión de resultados de investigación empírica que desarrollamos a lo largo de cuatro años en escuelas emplazadas en contextos de extrema pobreza urbana, intentamos describir las particulares formas en que la vida escolar es producida en estos espacios urbanos. Desde la perspectiva de los estudios de gubernamentalidad, procuramos la descripción de las formas que están asumiendo los dispositivos pedagógicos y la producción de subjetividad en territorios abyectos en los que, en el marco de las sociedades de gerenciamiento, la población ha quedado librada a su propia suerte. Propondremos una forma de leer las políticas educativas atendiendo a las formas en que son experienciadas por los sujetos en territorio.

Reverse logistics systems for waste generated throughout vehicles life-cycle

Waste produced during the service life of automobiles has received much less attention than end-of-life vehicles themselves. In this paper, we deal with the set up of a reverse logistics system for the collection and treatment of use-phase residues. First, the type of waste arising during vehicles? service life is characterized. Data were collected in collaboration with SIGRAUTO, the product stewardship organization in charge of vehicles? recovery in Spain. Next, three organizational models are proposed. The three alternatives are benchmarked and assessed from a double organizational and operational perspective for the particular case of the Madrid region in Spain

Continental Perspective 3, Spain

Well, I firmly believe that, as a professor, one has the duty, the obligation to show and explain his work. Not, of course, as a model to imitate, but rather as an opportunity to reflect upon that work. So, I will try to explain some of the considerations that were crucial in the development of each project. It is my hope that these reflections may be of interest to you, and due to my optimistic nature, that you may even enjoy it. Today I am going to present some projects, from a specific point of view: that of MATERIALITY. This is why I decided to title this presentation ARCHITEXTURE: that is, architecture from the point of view of texture, the quality of its material. Our architecture wants to pay attention to materials; we like to use very physical materials. We try to explore the expressive possibilities of different materials. That allows us, on the one hand, to try to master different techniques, and exploit their potential. On the other hand, it also avoids the dangers of style. Style is the death of an architect. When he starts repeating formulas, avoiding experimentation, copying himself, he dies of boredom, of intellectual boredom. Nevertheless, I don’t believe that the material itself determines anything. Architecture is an exercise of the freedom of an architect. Almost nothing is a given. Of course, there is the law of gravity and economic restraints, and even the overwhelming building code. But the most determinant factor is always the freedom of the architect, derived from his mastery of knowledge and culture, and his decision to innovate and to take risks

The new challenges of end-of-life tyres management systems: a Spanish case study

Directive 2008/98/EC released by the European Union represents a significant step forward in all relevant aspects of waste management. Under the already established, extended produced responsibility (EPR) principle, new policies have been enunciated to continuously achieve better overall environmental performance of key products throughout their life phases. This paper discusses how the directive is being articulated in Spain by the main integrated management system (IMS) for end-of-life (EOL) tyres since its creation in 2006. Focusing on the IMS technological, economic and legal aspects, the study provides a global perspective and evaluation of how the IMS is facing the current issues to resolve, the new challenges that have appeared and the management vision for the coming years.

Speech features of the domain of the word in heterosexual twins during the second yeard of life

Speech is the major function, emergence and which development radically changes all course of formation of the identity of the child already in the early childhood. If language and speech development in solitary born children is investigated today quite well, at twin children this process practically is not studied. Our research was carried out for the purpose of studying of an originality of mastering by speech by heterosexual children of pair of twins within communicative and pragmatist approach (T.N. Ushakov,G. V. Chirkina). Application of this approach to the analysis of process of communication at twin children allowed us to allocate those peculiar receptions and means of communication which they functionally develop in a situation of pair of twins, as allows them to show the phenomena of the speech which are not meeting at solitary born contemporaries. In this work results of supervision and research of pair of heterosexual twins of the second year of the life, carried out by a technique developed by us under the scientific guide of G. V. Chirkina

Managing Soil Organic Carbon: A Farm Perspective

Farming practices that lead to declining returns and inputs of carbon to soils pose a threat to key soil functions. The EU FP 7 interdisciplinary project Smart SOIL is using scientific testing and modeling to identify management practices that can optimize soil carbon storage and crop productivity. A consultation with advisors and policymakers in six European case study regions seeks to identify barriers to, and incentives for, uptake of such practices. Results from preliminary interviews are reported. Overall advisor and farmer awareness of management practices specifically directed towards soil carbon. is low. Most production- related decisions are taken in the short term, but managing soil carbon needs a long- term approach. Key barriers to uptake of practices include: perceived scientifi c uncertainty about the effi cacy of practices; lack of real life ?best practice? examples to show farmers; diffi culty in demonstrating the positive effects of soil carbon management practices and economic benefi ts over a long time scale; and advisors being unable to provide suitable advice due to inadequate information or training. Most farmers are unconvinced of the economic benefi ts of practices for managing soil carbon. Incentives are therefore needed, either as subsidies or as evidence of the cost effectiveness of practices. All new measures and advice should be integrated into existing programmes to avoid a fragmented policy approach.

Performance and Professional Skills in an Online Java Programming Course for Engineering Students

The main purpose of this work is to describe the case of an online Java Programming course for engineering students to learn computer programming and to practice other non-technicalabilities: online training, self-assessment, teamwork and use of foreign languages. It is important that students develop confidence and competence in these skills, which will be required later in their professional tasks and/or in other engineering courses (life-long learning). Furthermore, this paper presents the pedagogical methodology, the results drawn from this experience and an objective performance comparison with another conventional (face-to-face) Java course.

The usefulness of Usability and User Experience evaluation methods on an e-Learning platform development from a developer's perspective: A case study

The development of a web platform is a complex and interdisciplinary task, where people with different roles such as project manager, designer or developer participate. Different usability and User Experience evaluation methods can be used in each stage of the development life cycle, but not all of them have the same influence in the software development and in the final product or system. This article presents the study of the impact of these methods applied in the context of an e-Learning platform development. The results show that the impact has been strong from a developer's perspective. Developer team members considered that usability and User Experience evaluation allowed them mainly to identify design mistakes, improve the platform's usability and understand the end users and their needs in a better way. Interviews with potential users, clickmaps and scrollmaps were rated as the most useful methods. Finally, these methods were considered unanimously very useful in the context of the entire software development, only comparable to SCRUM meetings and overcoming the rest of involved factors.